Off-pump bilateral internal thoracic artery grafting in right internal thoracic artery to right coronary system
Hyun-Chel Joo1, Young-Nam Youn, Gijong Yi
1Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea.
Insights
Bilateral internal thoracic artery (ITA) grafts showed no midterm advantage over single ITA grafts in off-pump coronary artery bypass surgery. Outcomes including survival and major adverse cardiac events were similar between bilateral and single ITA grafting at 10 years.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Grafting
Background:
- The superiority of bilateral internal thoracic artery (BITA) grafts over single internal thoracic artery (SITA) grafts in coronary artery bypass grafting (CABG) remains debated.
- This study investigates midterm outcomes comparing BITA to SITA grafting in off-pump coronary artery bypass (OPCAB).
Purpose of the Study:
- To compare midterm outcomes of BITA versus SITA grafting in OPCAB.
- To evaluate the efficacy of right internal thoracic artery (RITA) to right coronary artery (RCA) system anastomosis in BITA grafting.
Main Methods:
- A propensity score-matched analysis of 1,749 patients undergoing isolated OPCAB with ITA grafts (2000-2009).
- 366 BITA patients were matched to 366 SITA patients.
- Midterm survival and major adverse cardiac and cerebrovascular event (MACCE) rates were compared over a mean follow-up of 84.46 months.
Main Results:
- No significant difference in overall survival at 10 years between BITA and SITA groups (84.6% vs 84.1%, p=0.955).
- Cardiac-related death-free rates at 10 years were similar (90.0% vs 90.9%, p=0.871).
- Major adverse cardiac and cerebrovascular event-free rates at 10 years did not significantly differ (79.7% vs 74.6%, p=0.303).
Conclusions:
- Bilateral internal thoracic artery grafting did not demonstrate superior midterm outcomes compared to single internal thoracic artery grafting in the RITA to RCA system.
- At 10-year follow-up, BITA grafting showed comparable overall survival, cardiac survival, and MACCE rates to SITA grafting in OPCAB.
Background:
Despite many large-volume studies on the use of bilateral internal thoracic artery (ITA) grafts, the benefits of a bilateral (B)ITA graft over a single (S)ITA graft for CABG remain controversial. This study compared midterm outcomes of BITA to SITA grafting in off-pump coronary artery bypass (OPCAB), focusing primarily on the right (R)ITA to right coronary artery (RCA) system.
Methods:
From January 2000 to December 2009, 1,749 patients underwent isolated OPCAB with ITA grafts. Using propensity score matching, 366 BITA patients could be pairwise propensity matched to a SITA patient. We compared midterm survival and major adverse cardiac and cerebrovascular event (MACCE) between the 2 groups. All patients in the BITA group underwent bilateral ITA grafting with the RITA anastomosed to the RCA system. Mean follow-up was 84.46±24.47 months (range, 5 to 120 months).
Results:
Overall survival at 10 years was not significantly different between the 2 groups (84.6% vs 84.1%; p=0.955). The 10-year cardiac-related death-free rate also did not significantly differ between the groups (90.0% vs 90.9%; p=0.871). The 10-year MACCE-free rate did not significantly differ between the 2 groups (79.7% vs 74.6%; p=0.303).
Conclusions:
At 10-year follow-up, BITA grafting did not offer advantages over SITA grafting in midterm outcomes, at least in the RITA to RCA system. The BITA grafting was similar to SITA grafting in overall and cardiac survival, and MACCE rates.
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